A Biopsychosocial Analysis of Recurrent Major Depressive Disorder with Psychotic Symptoms in Young Adults: A Clinical Case Study

Dennis Onesimus Indra; Juniar  Effendi; Anastasia Ratnawati  Biromo

doi:10.58344/ihj.v5i3.961

Authors

Dennis Onesimus Indra Universitas Tarumanagara
Juniar Effendi Universitas Tarumanagara
Anastasia Ratnawati Biromo Universitas Tarumanagara

DOI:

https://doi.org/10.58344/ihj.v5i3.961

Keywords:

Depression, Psychotic Symptoms, Biopsychosocial, Suicide, Young Adults

Abstract

Major depressive disorder with psychotic features is a severe mental health condition associated with an elevated risk of suicide, particularly among young adults exposed to significant psychosocial stressors. This study aimed to analyze the biopsychosocial factors associated with recurrent major depressive disorder with psychotic features through a clinical case study approach. A qualitative descriptive case study was conducted involving a 20-year-old female patient who received treatment at a regional psychiatric hospital. Data were collected through autoanamnesis, alloanamnesis, clinical observation, and mental status examination, and were analyzed using a biopsychosocial approach. The findings showed that the patient experienced severe depressive symptoms, including persistent sadness, social withdrawal, sleep disturbances, and loss of motivation, accompanied by psychotic symptoms in the form of auditory command hallucinations and suicidal ideation. The condition was precipitated by acute stressors, including betrayal by a close friend and job loss, and was exacerbated by a history of family conflict and limited emotional support. The diagnosis was established as recurrent major depressive disorder with a severe episode and psychotic features. In conclusion, the interaction of biological, psychological, and social factors plays an important role in the development and severity of the disorder. A comprehensive biopsychosocial approach is required to reduce suicide risk and improve patient outcomes.

References

Fitrianti, M. Y., Ula, M. R., Sarifah, M. C., & Fachir, S. N. I. (2026). The relationship of psychiatric disorders to suicide cases and implications in forensic medicine investigations: A review of the literature. Scientific Periodical of Medicine and Public Health, 4(1). https://journal.uii.ac.id/BIKKM/article/view/40763

Fusar-Poli, P., Correll, C. U., Arango, C., Berk, M., Patel, V., & Ioannidis, J. P. A. (2021). Preventive psychiatry: A blueprint for improving the mental health of young people. World Psychiatry, 20(2), 200–221.

Hales, R. E. (2008). The American psychiatric publishing textbook of psychiatry. American Psychiatric Publishing.

Herrenkohl, T. I., Fedina, L., Roberto, K. A., Raquet, K. L., Hu, R. X., Rousson, A. N., & Mason, W. A. (2022). Child maltreatment, youth violence, intimate partner violence, and elder mistreatment: A review and theoretical analysis of research on violence across the life course. Trauma, Violence, & Abuse, 23(1), 314–328.

Jääskeläinen, E., Juola, T., Korpela, H., Lehtiniemi, H., Nietola, M., Korkeila, J., & Miettunen, J. (2018). Epidemiology of psychotic depression: Systematic review and meta-analysis. Psychological Medicine, 48(6), 905–918.

Kehinde, F., Bharmal, A. V., Goodyer, I. M., et al. (2022). Cross-sectional and longitudinal associations between psychotic and depressive symptoms in depressed adolescents. European Child & Adolescent Psychiatry, 31, 729–736. https://doi.org/10.1007/s00787-020-01704-3

McCrory, E. J., & Viding, E. (2015). The theory of latent vulnerability: Reconceptualizing the link between childhood maltreatment and psychiatric disorder. Development and Psychopathology, 27(2), 493–505.

Moe, A. M., & Breitborde, N. J. K. (2019). Psychosis in emerging adulthood: Phenomenological, diagnostic, and clinical considerations. Evidence-Based Practice in Child and Adolescent Mental Health, 4(2), 141–156.

Novtarina, R., KH, H. B., & Graharti, R. (2025). Episodes of major depression with psychotic symptoms in 17-year-old women: A case report. Medical Profession Journal of Lampung, 15(3), 586–592. https://doi.org/10.53089/medula.v15i3.1674

Nuzulia, A., & Hidayati, E. (2025). The effectiveness of expressive writing and playing therapy to reduce symptoms of major depression without psychotic symptoms. Procedia: Case Studies and Psychological Interventions, 13(2), 135–142. https://doi.org/10.22219/procedia.v13i2.37833

O’Neill, L., Fraser, T., Kitchenham, A., & McDonald, V. (2018). Hidden burdens: A review of intergenerational, historical and complex trauma, implications for indigenous families. Journal of Child & Adolescent Trauma, 11(2), 173–186.

Razaq, S., & Amin, S. (2024). Psychotic depression. InnovAiT: Education and Inspiration for General Practice, 17(9–10), 444–450. https://doi.org/10.1177/17557380241265622

Saputri, P. R. J., & Vrisaba, N. A. (2025). Inferiority dynamics in adolescents with major depression and psychotic symptoms in the perspective of individual psychology. Character Journal of Psychological Research, 12(3), 998–1007. https://doi.org/10.26740/cjpp.v12n03.p998-1007

Shah, J. L., Scott, J., McGorry, P. D., Cross, S. P. M., Keshavan, M. S., Nelson, B., Wood, S. J., Marwaha, S., Yung, A. R., & Scott, E. M. (2020). Transdiagnostic clinical staging in youth mental health: A first international consensus statement. World Psychiatry, 19(2), 233–242.

Southern, S., & Sullivan, R. D. (2021). Family violence in context: An intergenerational systemic model. The Family Journal, 29(3), 260–291.

Timshel, I., Montgomery, E., & Dalgaard, N. T. (2017). A systematic review of risk and protective factors associated with family related violence in refugee families. Child Abuse & Neglect, 70, 315–330.

Wang, M. Q., Wang, R. R., Hao, Y., et al. (2021). Clinical characteristics and sociodemographic features of psychotic major depression. Annals of General Psychiatry, 20, 24. https://doi.org/10.1186/s12991-021-00341-7

Widodo, Y. W. P., & Ambarini, T. K. (2024). A case study: Empty chair therapy for a survivor of suicide with depression with psychotic. Psikoborneo: Scientific Journal of Psychology, 12(2), 205–211. https://doi.org/10.30872/psikoborneo.v12i2.14685

Wu, Y., Zhao, X., Li, Z., et al. (2024). Prevalence and risk factors for psychotic symptoms in young, first-episode and drug-naïve patients with major depressive disorder. BMC Psychiatry, 24, 66. https://doi.org/10.1186/s12888-024-05517-5

Yang, R., Li, Z., Zhu, Y., et al. (2024). Non-linear relationship between TSH and psychotic symptoms in first episode and drug-naïve major depressive disorder patients: A large sample sized cross-sectional study in China. BMC Psychiatry, 24, 413. https://doi.org/10.1186/s12888-024-05860-7

Yulian Sari. (2025). Factors related to the incidence of acute psychotic disorders at Regional Psychiatric Hospital Dr. Samsi Jacobalis Bangka Belitung Islands Province in 2024. Journal of Nursing Sisthana, 10(1), 57–64. https://doi.org/10.55606/sisthana.v10i1.1654